No abstract available.
Transplants*

No abstract available.
Acrocephalosyndactylia* ; Hypertelorism* ; Orbit*

The skyrocketing inflation of medical costs has become a major health problem among most developed countries. Korea, which recently covered the entire population with National Health Insurance, is facing the same problem. The proportion of health expenditure to GNP has increased from 3% to 4.8% during the last decade. This was remarkable, if we consider the rapid economic growth during that time. A few policy analysts began to raise cost containment as an agenda, after recognizing the importance of medical cost inflation. In order to prepare an appropriate alternative for the agenda, it is necessary to find out reasons for the cost inflation. Then, we should focus on the reasons which are controllable, and those whose control are socially desirable. This study is designed to articulate the theory of medical cost inflation through literature reviews, to find out reasons for cost inflation, by analyzing aggregated data with a deterministic model. Finally to identify determinants of changes in both medical demand and service intensity which are major reasons for cost inflation. The reasons for cost inflation are classified into cost push inflation and demand pull inflation. The former consists of increases in price and intensity of services, while the latter is made of consumer derived demand and supplier induced demand. We used a time series (1983-1987), and cross sectional (over regions) data of health insurance. The deterministic model reveals, that an increase in service intensity is a major cause of inflation in the case of inpatient care, while, more utilization, is a primary attribute in the case of physician visits. Multiple regression analysis shows that an increase in hospital beds is a leading explanatory variable for the increase in hospital care. It also reveals, that an introduction of a deductible clause, an increase in hospital beds and degree of urbanization, are statistically significant variables explaining physician visits. The results are consistent with the existing theory. The magnitude of service intensity is influenced by the level of co-payment, the proportion of old age and an increase in co-payment. In short, an increase in co-payment the utilization, but it induced more intensities or services. We can conclude that the strict fee regulation or increase in the level of co-payment can not be an effective measure for cost containment under the fee for service system. Because the provider can react against the regulation by inducing more services.
Cost Control ; Developed Countries ; Economic Development ; Fee-for-Service Plans ; Fees and Charges ; Health Expenditures ; Humans ; Inflation, Economic* ; Inpatients ; Insurance, Health ; Korea ; National Health Programs ; Urbanization

No abstract available.
Durapatite* ; Dust* ; Rabbits* ; Transplants*

No abstract available.
Facial Nerve*

No abstract available.
Burns* ; Granulation Tissue*

PURPOSE: Hypothalamic hamartomas are non-neoplastic malformations which are composed of hyperplastic neuronal tissue of varying size. Clinically, they are characterized by gelastic seizure, precocious puberty, and behavioral and psychiatric disorders. This study was performed to examine the various features of hypothalamic hamartomas such as neurologic manifestations, other clinical manifestations, and EEG and brain MRI findings. Response to AEDs or outcome of operation on hypothalamic hamartoma was evaluated. METHODS: Eleven patients who were admitted to Seoul National University Children's Hospital from July 1986 to January 1997 and diagnosed as hypothalamic hamartoma by brain MRI or CT were enrolled in this study. Clinical manifestations and EEG were reviewed retrospectively through the medical records. The size and type of the hypothalamic hamartoma on brain MRl were analyzed. RESULTS: 1) The range of age at visit was 1yr 9mo to 17yr 2mo (mean 10yr 8mo), and the age at onset was 1yr 1mo to 14yr to 2mo (mean 5yr 8mo). Six patients were male and five were female. 2) The clinical manifestations included gelastic seizure (n=9), behavioral and psychiatric disorders (n=9), other types of seizure (n=8), and precocious puberty (n=6). Other types of seizure were complex partial seizure (n=3), generalized tonic seizure(n=3), and infantile spasm (n=2). 3) The interictal EEG findings included focal spike discharges (n=8), diffuse delta slowings (n=1), hypsarrhythmia (n=1), and normal record (n=1). The focal spike discharges originated from the temporal (n=2), fronto-temporal (n=1), occipital (n=3), or frontal area(n=2). 4) The brain MRI showed that the size of the hypothalamic hamartomas was 2.47+/-1.12cm, and the origin of the tumors was tuber cinereum (n=6) or tuber cinereum and mamillary body (n=5). All lesions were isointense on T1-weighted image relative to normal gray matter, with a sessile attachment to the hypothalamus, and were not enhanced by Gadolinium. 5) Operations were done in 5 cases, those were subtotal removal of the tumor (n=4), and gamma knife radiosurgery (n=1). Seizures were not completely controlled in all but one case on which gamma knife radiosurgery was done. CONCLUSIONS: The hypothalamic hamartomas presented variable clinical pictures including gelastic seizure, precocious puberty, and behavioral and psychiatric disorders. The gelastic and other types of seizure associated with hypothalamic hamartomas were refractory to medication and might be controlled by total removal of the tumor.
Brain ; Electroencephalography ; Female ; Gadolinium ; Hamartoma* ; Humans ; Hypothalamus ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging* ; Male ; Mamillary Bodies ; Medical Records ; Neurologic Manifestations ; Neurons ; Puberty, Precocious ; Radiosurgery ; Retrospective Studies ; Seizures ; Seoul ; Spasms, Infantile ; Tuber Cinereum

Primary splenic tumors are rare and mainly found incidentally on radiologic studies. Among them, sclerosing angiomatoid nodular transformation (SANT) of the spleen is a new entity defined as a benign pathologic lesion. Most SANTs have no clinical symptoms and are occasionally accompanied by other splenic diseases such as malignancies. So, the exact diagnosis of the nature of the splenic tumor is mandatory for further treatment. But, preoperative diagnosis is not easy since it is difficult to obtain the tissue from the spleen for pathological study. Recently, laparoscopic splenectomy has become the more standard procedure for the spleen for diagnosis and treatment. Here, we report a rare case of SANT diagnosed following laparoscopic splenectomy.
Spleen ; Splenectomy ; Splenic Diseases

The mandible with the lower maxilla comprises the lower third of the face. A correction of the mandible in facial asymmetry would be helpful in improving aesthetic appearance. In general, surgical techniques for improving the contour of lower jaw deformities include correcting the deficient mandible by osteotomies, distraction osteogenesis and the augmentation of the mandible with alloplastic or autogenous materials. In a patient with satisfactory occlusal relationships and mild hypoplasia, alloplastic material for augmentation of the mandible on the affected side is more practical than autogenous augmentation. The porous high density polyethylene (PHDPE) implant is a widely available alloplast which is an attractive alternative to other alloplasts and autogenous tissues. Thirteen patients (8 men, 5 women), ages ranging from 17 to 47 years old, have types IA (n = 6) and IB (n = 5) hemifacial microsomia(Munro and Lauritzen, 1985), Klippel-Feil syndrome (n = 1), Romberg's disease (n = 1) were corrected with prefabricated porous high density polyethylene over a 4 year period (1996- 1999). The average follow-up period was 12 months, however the range has been between 6 and 36 months. Preoperative planning was done based on an aesthetic assessment of thickness of the soft tissue, the use of life size photographs, cephalometric and panorex x-rays and three dimensional computed tomography. The surgical technique consists of an intraoral approach incision, the an implant was placed subperiostealy, appropriately sculptured and fixed to posterior and inferior border of the mandible at the gonial angle. In four patients the implant had to be removed due to complications which included three cases of infection and one case of extrusion by iatrogenic trauma. One of the above four patients' implant was replaced with a smaller one, approximately 3 months after its removal. With the others nine patients there was no infection or permanent morbidity. Postoperative appearance was considered very satisfactory, the mandible was well outlined, and the facial proportions were improved. Porous high density polyethylene implant is recommended for hypoplastic mandible augmentation when proper indication are strictly observed and surgical steps are accurately followed.
Congenital Abnormalities ; Facial Asymmetry ; Facial Hemiatrophy ; Follow-Up Studies ; Humans ; Jaw ; Klippel-Feil Syndrome ; Male ; Mandible* ; Maxilla ; Middle Aged ; Osteogenesis, Distraction ; Osteotomy ; Polyethylene*

One of the problems in the correction of the cleft lip nose deformity is the hypoplastic alar nasi on the affected side, even after secondary rhinoplasty. This deformity was managed with various cartilage grafts for augmentation of the cleft side, but that procedures have been complicated by inadequate cartilage augmentation, complex procedure, unpredictable results. To overcome the problem of the hypoplastic alar nasi, the authors used subcutaneous reduction of the upper part of the ala and external lateral triangle on the non-cleft side through the intranasal approach. Additional techniques including partial-thickness incisions of the septal cartilage, freeing of the septal cartilage from the vomer, the nasal osteotomy, a z-plasty on the affected plica vestibularis and cinching of denuded alar base of the affected side or an interalar cinch were also used to repair individual differences of the nasal deformities. The authors performed 20 cases (11 women and 9 men) of the correction of the unilateral cleft lip nose deformity between 1997 and 1999. The patient, ranged in age from 19 years to 51 years at the time of surgery, with a mean age of 24 years. Eight to twenty (mean twelve) months postoperatively, the patients were evaluated by the ordinary scale method and the photogrammetric measurements using preoperative and postoperative photos. All the patients showed uneventful healing except two cases of superficial skin necrosis. By the ordinary scale method, "good" aesthetic results were noted. By the photogrammetric measurement, the alar height of non-cleft were significantly decreased. The results showed a relatively symmetrical alar height index of both cleft and non-cleft sides. In conclusion, the procedure is very simple and fast to perform, and it is easy to achive nasal symmetry. It is possible to use the procedure with additional techniques in the various deformities for the better results.
Cartilage ; Cleft Lip* ; Congenital Abnormalities* ; Female ; Humans ; Individuality ; Necrosis ; Nose* ; Osteotomy ; Rhinoplasty ; Skin ; Transplants ; Vomer